| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,550 |
1,894 |
$474K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,327 |
1,470 |
$251K |
| D2394 |
|
1,314 |
626 |
$210K |
| D0140 |
Limited oral evaluation - problem focused |
5,525 |
5,336 |
$210K |
| D2335 |
|
1,604 |
512 |
$200K |
| D1110 |
Prophylaxis - adult |
4,969 |
4,945 |
$196K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,329 |
3,870 |
$194K |
| D0330 |
Panoramic radiographic image |
3,035 |
3,002 |
$182K |
| D1120 |
Prophylaxis - child |
6,087 |
6,052 |
$172K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,811 |
9,762 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,627 |
3,582 |
$165K |
| D1351 |
Sealant - per tooth |
5,488 |
1,416 |
$161K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,784 |
894 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
5,074 |
5,052 |
$136K |
| D0274 |
Bitewings - four radiographic images |
4,085 |
4,054 |
$135K |
| D0220 |
Intraoral - periapical first radiographic image |
8,685 |
8,499 |
$130K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,454 |
7,754 |
$128K |
| D0272 |
Bitewings - two radiographic images |
2,863 |
2,848 |
$55K |
| D4355 |
|
803 |
796 |
$54K |
| D9110 |
|
849 |
827 |
$38K |
| D9440 |
|
592 |
548 |
$33K |
| D2332 |
|
187 |
118 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
202 |
114 |
$13K |
| D4346 |
|
82 |
82 |
$3K |
| D7311 |
|
25 |
12 |
$3K |
| D2940 |
|
38 |
24 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
16 |
16 |
$316.50 |